**5. Treatment methods in anxiety disorders**

### **5.1 Cognitive - behavioral therapy**

It is a widely used, successful and easy method in the treatment of anxiety disorders. This short-term treatment method focuses on changing the patient's thoughts and behaviors. This treatment includes emotional and behavioral changes to help the person to adapt to the environment perceived to be dangerous, as well as the initial definition and restructuring of cognitions related to anxiety in the form of unreal interpretation of danger [9, 18–20]. In their study, Andrews et al. (2005) also found that virtual reality practice therapy is effective in treating public speaking anxiety [21].

#### *5.1.1 Systematic desensitization*

In systematic desensitization, the patient is gradually exposed to the effect of phobia stimuli in real or imaginary situations. The concept was first introduced by Joseph Wolpe in 1958 and is based on the principles of behavior conditioning. Emphasis is placed on mutual inhibition or mutual conditioning [22].

*Mutual inhibition* is defined as limiting anxiety before trying to reduce avoidance behaviors. The rationale behind this concept is that individuals cannot be excited and relaxed at the same time, as relaxation is the opposite of anxiety [23].

There are two important elements in systematic desensitization by mutual inhibition:

### 1.Practicing relaxation techniques

2.Gradual exposure to fear stimuli in a relaxed state.

The individual is taught the art of relaxation by using techniques that are more effective for him/her (e.g. progressive relaxation, mental imagination, tension and relaxation, meditation). After the individual learns relaxation techniques, exposure to phobic stimuli is initiated. The patient is asked to rank hierarchically the situations that cause phobic stimuli from the most disturbing to the least disturbing. In case of maximum relaxation, the patient may be asked to visualize the phobic stimulus in his/her mind. First of all, the exposure focuses on the phobic stimulus that

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*Anxiety Disorders*

*5.1.2 Flooding therapy*

beginning of the sessions [24].

individual should be added [26].

**5.3 Psychopharmacology**

*5.1.3 Relaxation exercise*

techniques [25].

**5.2 Family therapy**

*DOI: http://dx.doi.org/10.5772/intechopen.93952*

causes the least fear or anxiety. In subsequent sessions, the individual is exposed to the effects of increasingly more fearful stimuli. Sessions can be conducted in imaginary, real-life situations (live), or sometimes a combination of both [1].

*Flooding* is the therapeutic process that involves the patient participating in real-life events or imaginary situations that s/he thinks to be extremely fearful for a long time. Relaxation training is not part of the technique. Such sessions should be given a long period because short periods can be ineffective and even harmful. The sessions are terminated when the patient reacts significantly less than s/he did at the

Relaxation exercise is a method that effectively reduces tension and anxiety. It can be used alone or in conjunction with other cognitive-behavioral

Families have difficulties in understanding the symptoms of their relatives with anxiety disorders and may find it hard to tolerate, and this situation can disrupt the healthy family structure. It is important to remind family members of their roles in therapy and to emphasize that support is important. Besides, it is necessary to inform them about anxiety disorder symptoms and treatments [1]. In another study conducted, it was concluded that treatments aimed at reducing symptoms only were insufficient in the treatment of anxiety disorders and that programs for improving interpersonal relationships, communication skills and anger management of the

*Anxiolytics:* Benzodiazepines are used successfully in the treatment of common anxiety disorders. It can be prescribed when the patient is particularly anxious. Alprazolam, lorazepam and clonazepam are particularly effective in treating panic disorder. In Benzodiazepine *treatment*, there are physical addiction and tolerance risks that can lead to addiction. This is because deprivation symptoms can be life-threatening, so patients should be warned against sudden termination of drug intake, and drug termination should be done with treatment. Due to potential for addiction, benzodiazepines, SSRIs, serotonin, and norepinephrine reuptake inhibi-

Buspirone, which as an anti-anxiety agent, is effective in approximately 60% to 80% of patients with a generalized anxiety disorder [3]. The only disadvantage of buspirone is the 10-14 day delay in relieving symptoms. However, the lack of physical addiction and tolerance disadvantage of buspirone makes it the drug of choice in the treatment of generalized anxiety disorders. The effects and side effects

*Antidepressants:* Many antidepressants are as effective as anti-anxiety agents. Tricyclic, clomipramine and imipramine drugs are used successfully in patients with panic disorder. However, after the discovery of SSRIs, tricyclics are used less frequently because they tend to cause side effects when given in desired high doses

tors (SNRs), and buspirone are the first-line therapy [27].

of anxiolytic agents are given in **Table 2**.

to alleviate panic disorder symptoms [15].

causes the least fear or anxiety. In subsequent sessions, the individual is exposed to the effects of increasingly more fearful stimuli. Sessions can be conducted in imaginary, real-life situations (live), or sometimes a combination of both [1].

## *5.1.2 Flooding therapy*

*Anxiety Disorders - The New Achievements*

**medication-induced anxiety**

**5. Treatment methods in anxiety disorders**

**5.1 Cognitive - behavioral therapy**

ing anxiety [21].

inhibition:

*5.1.1 Systematic desensitization*

1.Practicing relaxation techniques

2.Gradual exposure to fear stimuli in a relaxed state.

treatment are benzodiazepines, SSRI, buspirone and venlafaxine. Benzodiazepines in treatment should be started with the lowest dose of the therapeutic range to be

**4.8 Anxiety disorder associated with another medical condition and substance/**

Symptoms associated with these disorders are evaluated directly as a physiological consequence of another medical condition or directly due to substance intoxication or deprivation or exposure to the drug. Many medical conditions are related to the development of anxiety symptoms. Some of these include cardiac conditions such as myocardial infarction, congestive heart failure and mitral valve prolapse, endocrine conditions such as hypoglycemia, hypo/hyperthyroidism and pheochromocytoma, respiratory conditions such as chronic obstructive pulmonary disease and hyperventilation, and complex partial seizures, neoplasms and encephalitis [12].

It is a widely used, successful and easy method in the treatment of anxiety disorders. This short-term treatment method focuses on changing the patient's thoughts and behaviors. This treatment includes emotional and behavioral changes to help the person to adapt to the environment perceived to be dangerous, as well as the initial definition and restructuring of cognitions related to anxiety in the form of unreal interpretation of danger [9, 18–20]. In their study, Andrews et al. (2005) also found that virtual reality practice therapy is effective in treating public speak-

In systematic desensitization, the patient is gradually exposed to the effect of phobia stimuli in real or imaginary situations. The concept was first introduced by Joseph Wolpe in 1958 and is based on the principles of behavior conditioning.

*Mutual inhibition* is defined as limiting anxiety before trying to reduce avoidance behaviors. The rationale behind this concept is that individuals cannot be excited

Emphasis is placed on mutual inhibition or mutual conditioning [22].

and relaxed at the same time, as relaxation is the opposite of anxiety [23].

There are two important elements in systematic desensitization by mutual

The individual is taught the art of relaxation by using techniques that are more effective for him/her (e.g. progressive relaxation, mental imagination, tension and relaxation, meditation). After the individual learns relaxation techniques, exposure to phobic stimuli is initiated. The patient is asked to rank hierarchically the situations that cause phobic stimuli from the most disturbing to the least disturbing. In case of maximum relaxation, the patient may be asked to visualize the phobic stimulus in his/her mind. First of all, the exposure focuses on the phobic stimulus that

used and the dose should be increased in case of unresponsiveness [1].

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*Flooding* is the therapeutic process that involves the patient participating in real-life events or imaginary situations that s/he thinks to be extremely fearful for a long time. Relaxation training is not part of the technique. Such sessions should be given a long period because short periods can be ineffective and even harmful. The sessions are terminated when the patient reacts significantly less than s/he did at the beginning of the sessions [24].
